Medicaid Renewal Support Guidelines

Medicaid Changes Coming in 2027

Beginning Jan. 1, 2027, some Medicaid recipients (ages 19–64) will have new requirements to keep their coverage. Below is a list of supports to assist you in navigating the change with your UPMC for You patients. 

Who will be affected?

  • Some working-age adults (ages 19–64) enrolled in Medicaid may be affected by HR1 policy changes. Effects will vary based on individual eligibility and circumstances.

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What are the changes coming for Medicaid renewal?

The changes will vary based on individual eligibility and circumstances.

Some Medicaid recipients will need to:

  1. Renew their coverage every 6 months instead of every 12 months.
  2. Complete work and community engagement requirements.

To meet the requirements, nonexempt individuals must do one or more of the activities for at least 80 hours per month:

  • Work
  • Volunteer or community service
  • Job training programs
  • School or education programs

Requirements will be reviewed when individuals apply or renew coverage. The Pennsylvania Department of Human Services (DHS) will use any one of the six months prior to their renewal date to “count” toward the community engagement/work requirements. DHS will require recipients to meet this requirement at the time of applying.

Medicaid recipients who must meet work and community engagement rules will start to hear from PA DHS about the new requirements by September 2026; however, there are exemptions.

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Are there any exemptions from the new requirements?

Yes. Medicaid recipients can be exempt from the work and community engagement requirements if they are/were:

  • Parents/Caretakers of a child under 14. 
  • Parents/Caretakers of an individual with a disability. 
  • Pregnant or postpartum (for up to one year postpartum). 
  • Former foster care under the age of 26.
  • Native American/American Indian or an Alaska Native. 
  • Veteran with a VA-determined total disability.
  • Treatment for alcohol or substance use disorder. 
  • Considered medically frail or have special medical needs. 
  • Incarcerated in the last 90 days. 

Medicaid Changes Communications Toolkit

Additional exemptions may apply. Patients can visit Pennsylvania DHS’ website for the most up-to-date information.

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What can my UPMC for You patients do to stay informed? 

  • Keep contact information up to date. Patients should update their address with DHS (dhs.pa.gov/COMPASS) and with the U.S. Postal Service (USPS.com/move). 
  • Enroll in notifications from DHS. Patients can sign up for texts and emails from DHS to receive notifications from DHS (dhs.pa.gov/text).  
  • Respond to DHS’s renewal requests. Complete renewals and submit documents on time to avoid coverage gaps. 

Many states must implement work requirements, more frequent eligibility re-determinations, and new data collection on enrollees and providers starting Jan. 1, 2027. For providers who see patients in multiple states, refer to guidance from your state’s DHS for the most relevant information.  

Patients who have questions can call 877-395-8930. Philadelphia residents may call 215-560-7226. Representatives are available Monday, Tuesday, Wednesday, and Friday from 8 a.m. to 4:30 p.m.; and Thursdays from 11 a.m. to 4:30 p.m.

Patients can complete their renewal over the phone by contacting the Consumer Service Center for Health Care Coverage at 866-550-4355.

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As a provider, what can I do to support my UPMC for You patients who are affected by this change?

Complete a Prescription for Wellness for your patients

Prescription for Wellness is a nationally recognized, Six Sigma-developed best-practice system that provides a convenient and effective way for providers to prescribe resources and support offered by UPMC Health Plan to their patients who are UPMC Health Plan members. Depending on the practice setting, providers can write a Prescription for Wellness using EpicCare or the Health Plan’s Provider OnLine (for practices with an alternative EMR).

Through Prescription for Wellness, providers can select from a comprehensive order set that includes services for:

  • Chronic condition management.
  • Lifestyle improvement.
  • Behavioral health.
  • Pharmacy interventions.
  • Health related social needs.*

*In the Health-related social needs category, providers can select “employment” as a topic to connect patients with a member of our Health Plan Clinical Team that will partner with your patient to explore employment, training, and education opportunities.

For more information visit our Prescription for Wellness page at or email the Prescription for Wellness team at RxforWellness@upmc.edu. 

Connect patients to potential employment and workforce developmental resources through the UPMC Pathways to Work program. 

Encourage patients to check DHS’s website for the most current updates

UPMC for You members can visit our dedicated website for information regarding Medicaid renewal guidelines. 

UPMC for You members can visit the DHS website to learn more about changes to the Medicaid program.

As a provider, you can enroll as a Community Partner to better support patients with the application and renewal process. Learn more by visiting the following links:

Other provider resources and HR1 education

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Where can UPMC for You Members get renewal and navigation support?

  • DHS Customer Service Center
    • Call 877-395-8930 with questions. Philadelphia residents may call 215-560-7226. Representatives are available, Monday, Tuesday, Wednesday, and Friday from 8 a.m. to 4:30 p.m.; and Thursdays from 11 a.m. to 4:30 p.m.
    • Members can complete a renewal over the phone by contacting the Consumer Service Center for Health Care Coverage at 866-550-4355.
  • COMPASS website and mobile app
    • COMPASS homepage
    • Members can complete renewals and manage benefit information online.

       

  • UPMC for You Renewal Support team
    • 800-978-8762 (Mon.–Fri., 8 a.m.–5 p.m.)
    • A telephonic specialist assists UPMC for You members with completing renewal over the phone.

       

  • UPMC for You Resource Navigation Hub
    • 833-716-8448 (Mon.–Fri., 9 a.m.–5 p.m.)
    • UPMC for You members can get help identifying renewal dates and connecting to community resources.

Employment and engagement resources

UPMC for You members can use the resources below to assist with finding employment, volunteer, and educational programs.  

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